Review article
Challenges in reducing the burden of otitis media disease: An ENT perspective on improving management and prospects for prevention

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Abstract

Acute otitis media (AOM) is a major public health concern. This frequent disease of childhood is a leading cause of physician visits, a major component of paediatric healthcare burden, and a key contributor to antibiotic resistance. An international expert group comprising mainly ear, nose, and throat physicians met in June 2008 to discuss the optimal management of AOM, particularly with regards to unmet needs in diagnosis and management. Current guidelines do not help identify which patients are most at risk for severe or complicated AOM. Diagnosis of AOM is also complicated by a lack of correlation between clinical signs and symptoms and responsible pathogens. Consequently, treatment of AOM is not always appropriate, and the long-term overuse of antibiotics in AOM reduces the effectiveness of treatment and places children at risk for drug-resistant infections. There is a need for educational and research initiatives to improve diagnostic accuracy and management of AOM. Because there is currently no ideal treatment, vaccination is an attractive additional approach for managing AOM and reducing its burden.

Section snippets

Otitis media

Otitis media (OM) is a major public health concern. Acute otitis media (AOM) is the most frequent disease of childhood, affecting millions of young children worldwide each year [1], [2]. AOM is a leading cause of physician visits and a major contributor to healthcare costs [3], [4], [5] and antibiotic use [3], [6], [7]. Furthermore, a substantial reduction in the use of antibiotics to treat AOM in children under two years of age is expected to help decrease bacterial resistance to antibiotics

Global burden of OM

OM is a continuum of disorders starting with a single episode of AOM that can notably progress to recurrent AOM or OM with effusion (Fig. 1) [13], [14]. AOM occurs in almost all children, and epidemiological data suggest that, by three years of age, 75–80% of children will have had at least one episode, with the peak incidence occurring before the age of two years [2], [15], [16]. In addition, more than 60% of episodes of symptomatic upper respiratory tract infections among children under three

Diagnosis of AOM

Although the presenting signs of AOM are well characterized, they are often non-specific and variable, complicating differential diagnosis [9], [26] (Table 2). A diagnosis of AOM requires a rapid onset of symptoms, the presence of middle ear effusion (otorrhoea or tympanic membrane changes), and signs of middle ear inflammation (otalgia or erythema of the tympanic membrane) [10]. Furthermore, there are no clearly identified prognostic indicators to help physicians determine which patients are

Vaccination as a potential solution to the universal problem of AOM

Paediatric vaccines have dramatically reduced the rates of invasive bacterial infections, which pose a morbid or potentially lethal threat to young children. Vaccination against H. influenzae type b, for example, has led to dramatic reduction in meningitis caused by this pathogen [50], [51], and vaccination against S. pneumoniae (7vCRM) has helped to lower the rates of meningitis, septicaemia, and pneumonia [52].

The 7vCRM vaccine offers limited protection against AOM. In the Finnish Otitis

Conclusions and recommendations

The diagnosis and management of OM remains a challenge, as there is no correlation between symptoms, the responsible pathogens, and the development of severe complications. Treatment of AOM is therefore not always appropriate (Fig. 2).

Current guidelines recommend watchful waiting or empirical treatment with antibiotics, but they do not provide guidance on which individuals are most at risk for severe or complicated disease. Complications such as recurrent OM contribute to the continued high

Acknowledgements

The First International ENT Roundtable Meeting was sponsored by GlaxoSmithKline Biologicals. This publication was sponsored and reviewed by GlaxoSmithKline Biologicals. We thank Dr. Winnie McFadzean (LiveWire Communications) and Dr. Julie Harriague (4Clinics), who provided medical writing services on behalf of GlaxoSmithKline Biologicals; Dr. Valentine Wascotte (GlaxoSmithKline Biologicals), Dr. Bernard Hoet (GlaxoSmithKline Biologicals), and Karen Palmer (LiveWire Communications) for

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